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Background People living with HIV (PLWH) presenting with advanced HIV have worse outcomes than those diagnosed earlier. The proportion of PLWH in Indonesia who are late presenters is unknown but likely high. Identifying factors associated with late presentation is key to earlier diagnosis and intervention. Methods Adult PLWH were enrolled at 19 centers across Indonesia (2018–2020) in the INA-PROACTIVE observational cohort study. Late presentation was defined as having a CD4+ count <350 cells/μl within 3 months of diagnosis. Risk factors were assessed using multivariable logistic regression. Findings Among 3201 eligible participants, 2790 (87·2%) were late presenters. High proportion of late presenters was observed from 2015 to 2019 (83·3%–89·8%). Characteristics associated with late presentation included age 30–39 (aOR = 1·47, 95% CI: 1·15–1·90) or age ≥40 (aOR = 1·71, 95% CI: 1·21–2·46) vs. age 18–29; male sex (aOR = 2·93, 95% CI: 2·07–4·24); diagnosis in ≤2015 (aOR = 1·45, 95% CI: 1·12–1·89); and diagnosis through Provider-Initiated Testing and Counseling (aOR = 2·38, 95% CI: 1·86–3·04) vs. Voluntary Counseling and Testing (VCT). Suspected MSM transmission was associated with lower odds of late presentation (aOR = 0·57, 95% CI: 0·39–0·82) compared to heterosexual transmission. Interpretation Late presentation remains highly prevalent in Indonesia. Expanded efforts are needed to promote testing among those at risk. Targeted interventions for older adults, men, and non-MSM populations, alongside VCT and MSM-focused programs, may help reduce late HIV diagnosis and improve early management. Funding This project has been funded in whole or in part with Federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health , under contract No. 75N91019D00024 Task orders 75N91020F00004, 75N91020F000012. © 2026 The Author(s).
Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jl. Percetakan Negara No.29, Kec. Johar Baru, Kota Jakarta Pusat, Daerah Khusus Ibukota Johar Baru, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Kenari, Kec. Senen, Daerah Khusus Ibukota Kota Jakarta Pusat, Jakarta, Indonesia; Faculty of Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Jl. Pasteur No.38, Bandung, Indonesia; Department of Internal Medicine, Faculty of Medicine, Udayana University, Jl. P.B Sudirman, Bali, Denpasar, Indonesia; The Kirby Institute, University of New South Wales, Sydney, Australia; Sulianti Saroso Infectious Disease Hospital, Jalan Baru Sunter Permai Raya, Tanjung Priok, Jakarta Utara, Indonesia; Tangerang District Hospital, Jalan Ahmad Yani No.9, Tangerang, Indonesia; St. Carolus Hospital, Jl. Salemba Raya No 41, Central Jakarta, Indonesia; Dr. Moch. Ansari Saleh Hospital, Jl. Brigjend H.Hasan Basri no. 1, Banjarmasin, Indonesia; Dr. T. C. Hillers Public Hospital, JI. Wairklau No.1, Kota Uneng, Kec. Alok, Kabupaten Sikka, Nusa Tenggara Timur, Indonesia; Persahabatan Central General Hospital, Jalan Persahabatan Raya No. 1, Rawamangun, Pulo Gadung, Daerah Khusus Ibukota Kota Jakarta Timur, Jakarta, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Jl. Diponegoro, Denpasar, Indonesia; Dr. Zainoel Abidin Hospital/Faculty of Medicine, Universitas Syiah Kuala, Jl. Tgk. Daud Beureueh No. 108, Bandar Baru, Kuta Alam, Kota, Banda Aceh, Indonesia; Soedarso General Hospital, Jl. Dr. Soedarso No. 1, Pontianak Tenggara, Kalimantan Barat, Kota Pontianak, Indonesia; Adam Malik Hospital, Jl. Bunga Lau No. 17, Kemenangan Tani, Medan Tuntungan, Medan, Indonesia; Wahidin Sudirohusodo General Hospital, Faculty of Medicine, Hasanuddin University, Jalan Perintis Kemerdekaan No.Km.11, South Sulawesi, Makassar, Indonesia; Department of Internal Medicine, Universitas Diponegoro/Dr, Kariadi Hospital, Jalan Dr Sutomo No. 16-18, Jawa Tengah, Semarang, Indonesia; Faculty of Medicine, Abdoel Wahab Sjahranie General Hospital, Universitas Mulawarman, Jl. Palang Merah Indonesia No 1, Samarinda, Indonesia; Department of Internal Medicine, Universitas Airlangga/Dr, Soetomo General Academic Hospital, Jalan. Prof. Mayjend. Dr. Moestopo 6 – 8, Surabaya, Indonesia; Abepura Regional General Hospital, JI. Kesehatan No.1, Abepura, Jayapura, Indonesia; Budi Kemuliaan Hospital, JI. Budi Kemuliaan No.1 Kel. Kp. Seraya, Kee. Batu Ampar, Batam, Indonesia; Department of Internal Medicine/Magister of Tropical Medicine Study Program, Universitas Gadjah Mada, Dr Sardjito General Hospital, JI. Farmako Sekip Utara, Radioputro Building 3rd Floor, Sleman, Yogyakarta, Indonesia; National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Lane, Rockville, MD, United States; Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia; Ngoerah Hospital/Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia; Cipto Mangunkusumo Hospital/Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia; Prof. Dr. Sulianti Saroso Infectious Disease Hospital,, North Jakarta, Indonesia; Faculty of Medicine, Universitas Hasanuddin/Dr, Wahidin Sudirohusodo Hospital, Makassar, Indonesia; Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia; Faculty of Medicine, Universitas Diponegoro/Dr. Kariadi Hospital, Semarang, Indonesia; Dr. Kariadi Hospital, Semarang, Indonesia; Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Faculty of Medicine, Universitas Gadjah Mada/Dr, Sardjito General Hospital, Yogyakarta, Indonesia; Persahabatan Central General Hospital, East Jakarta, Indonesia; Adam Malik Hospital, Medan, Indonesia; District Hospital, Tangerang, Indonesia; Dr. Moch. Ansari Saleh Hospital, Banjarmasin, Indonesia; St. Carolus Hospital, Central Jakarta, Indonesia; Budi Kemuliaan Hospital, Batam, Indonesia; Abdoel Wahab Sjahranie General Hospital, Faculty of Medicine, Universitas Mulawarman, Samarinda, Indonesia; Abdoel Wahab Sjahranie General Hospital, Samarinda, Indonesia; Dr. Zainoel Abidin Hospital/Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Dr. Soedarso General Hospital, Pontianak, Indonesia; Abepura Regional General Hospital, Papua, Jayapura, Indonesia; Dr. T. C. Hillers Public Hospital, Maumere, Indonesia; Health Policy Agency, Ministry of Health, Central Jakarta, Indonesia; Indonesia Research Partnership on Infectious Diseases (INARESPOND), Central Jakarta, Indonesia; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States; Leidos Biomedical Research, Inc, MD, United States
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